SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We assessed the value of cytology in the rapid diagnosis of bronchopneumonia at post mortem. Cytology scrapes were taken from 249 lung lobes during 50 autopsies. Slides were stained with a modified Giemsa technique and a neutrophil polymorph score recorded on a scale of 0-3. Histology blocks from the same area were then scored for the degree of bronchopneumonia present. Bronchopneumonia was found histologically in 22 patients, but macroscopic examination had identified only eight of these. A cytological neutrophil polymorph score of 2 or more to indicate bronchopneumonia yielded a sensitivity of 52% and a specificity of 98% in terms of lobes. This gave a positive predictive value of 92% and a negative predictive value of 86% for the presence of bronchopneumonia. All eight patients with a cytology score of 3 had histological evidence of bronchopneumonia. Conversely, all patients with a definitive diagnosis of bronchopneumonia exhibited cytology scores of at least 1. Post mortem cytology scrapes reliably predict bronchopneumonia and are superior to gross examination. This is a rapid, reliable and cheap method that can be readily performed in all necropsy practices.
A retrospective study was done on patients with bronchopneumonia hospitalized at the Dr. Pirngadi Hospital, Medan/School of Medicine, University of North Sumatera, during January 1985 through December 1989. The purpose of this study is to assess the morbidity and mortality of bronchopneumonia with measles and the nutritional status of the patients. Out of the 14.082 patients admitted, 1310 children suffered from bronchopneumonia (10.7%). Ninetynine of them were also with measles (7.6%). Most of the patients with bronchopneumonia without measles were in the age group 0-1 year (58.7%). The mortality was 24.8% and the highest mortality rate was in the age group of 4-5 years (34.6%). Most of the patients with bronchopneumonia and measles were in the age group of 1-2 years (30.3%). The mortality rate of bronchopneumonia with measles was 22.2% and the highest mortality rate was in the age group of 3-4 years (35.7%). Bronchopneumonia with or without measles occurred more in malnourished patients rather than in well-nourished cases. All of the patients who had bronchopneumonia with measles in the present study had never been immunized against measles.
OBJECTIVES: To assess histopathologists' ability to accurately diagnose bronchopneumonia, both on naked eye and microscopic examination; to extrapolate from the error rate to determine whether the role of the necropsy in monitoring the epidemiology of clinical error might be compromised. METHODS: Review of archival histological sections and necropsy reports from two teaching hospitals in Manchester. The main outcome measures identified were the proportions of macroscopic diagnoses of bronchopneumonia which were confirmed by the original pathologist on histological examination, and which could be confirmed on histological review by independent pathologists, together with the proportion of discrepant diagnoses remedied in the final report by the original pathologist. RESULTS: Of 279 cases where a macroscopic diagnosis of bronchopneumonia had been noted in the original provisional necropsy report, the original histopathologist described bronchopneumonia in only 206 (73.8%) in the subsequent final report, which took histology into account. Bronchopneumonia could be confirmed on independent histological review in only 193 (69.2%) of these cases. The original histopathologist diagnosed 74 cases of bronchopneumonia on histological grounds only, of which only 57 (77.0%) could be confirmed on review. Of a total of 160 discrepancies between the original naked eye diagnoses and the final reviewed diagnoses, only 130 (81.3%) had been remedied by the original pathologist. CONCLUSIONS: There is a considerable discrepancy rate between naked eye diagnoses of bronchopneumonia at necropsy and diagnoses confirmed on microscopy. If this discrepancy rate is extrapolated to other common lesions, then the role of the necropsy in clinical audit may be compromised. Pathologists need to take steps to monitor and improve their own diagnostic standards.
Many children do not survive after presentation in extremis. Some survive varying intervals and are found to have bronchopneumonia at death. The question is raised whether bronchopneumonia is a consequence of survival rather than the initiating disease leading to collapse. A prospective study of the deaths of 156 children divided them into two groups: 80 children with head injury and 76 with causes of death other than sudden infant death syndrome. In 43 of the total group of children, bronchopneumonia was found. In the total group, 76 survived more than a day. Of these 39 had bronchopneumonia, 32 died of head injury, and 7 had other causes of death. Of the children surviving less than a day, 4 had bronchopneumonia at death--only 1 with head injury. If bronchopneumonia is present, it is more likely to have developed after the collapse than to have caused it in this population.
BACKGROUND: Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalent doses of ceftazidime administered either intravenously or by ultrasonic nebulization using either nitrogen-oxygen or helium-oxygen as the carrying gas of the aerosol was compared in ventilated piglets with and without experimental bronchopneumonia. METHODS: Five piglets with noninfected lungs and 5 piglets with Pseudomonas aeruginosa experimental bronchopneumonia received 33 mg/kg ceftazidime intravenously. Ten piglets with noninfected lungs and 10 others with experimental P. aeruginosa bronchopneumonia received 50 mg/kg ceftazidime by ultrasonic nebulization. In each group, the ventilator was operated in half of the animals with a 65%/35% helium-oxygen or nitrogen-oxygen mixture. Animals were killed, and multiple lung specimens were sampled for measuring ceftazidime lung tissue concentrations by high-performance liquid chromatography. RESULTS: As compared with intravenous administration, nebulization of ceftazidime significantly increased lung tissue concentrations (17 +/- 13 vs. 383 +/- 84 microg/g in noninfected piglets and 10 +/- 3 vs. 129 +/- 108 microg/g in piglets with experimental bronchopneumonia; P < 0.001). The use of a 65%/35% helium-oxygen mixture induced a 33% additional increase in lung tissue concentrations in noninfected piglets (576 +/- 141 microg/g; P < 0.001) and no significant change in infected piglets (111 +/- 104 microg/g). CONCLUSION: Nebulization of ceftazidime induced a 5- to 30-fold increase in lung tissue concentrations as compared with intravenous administration. Using a helium-oxygen mixture as the carrying gas of the aerosol induced a substantial additional increase in lung deposition in noninfected piglets but not in piglets with experimental bronchopneumonia.
An investigation on the occurrence of different pneumonia types and their possible concurrence with other pluck organ disorders was made on 6,565 pigs presented at slaughter. The frequency of disseminated focal nephritis in a bronchopneumonia group and a non-bronchopneumonia residual group, respectively, was found to differ significantly from the mean frequency of nephritis in all pig plucks examined. The number of lesioned kidneys in each of 28 samples contributing to the bronchopneumonia group and in each of 8 samples contributing to the residual group was regressed group-wise on the number of individual plucks examined in each sample; the correlation coefficient for each of these two groups was calculated. These calculations showed a highly significant link between bronchopneumonia and disseminated focal nephritis. The histopathological and bacteriological examination of some lung and kidney lesions representing the bronchopneumonia group substantiated this finding. It is concluded that the two diseases are connected through dissemination, and that Pasteurella multocida is the organism involved in the majority of cases.
BACKGROUND: Pulmonary concentrations of aminoglycosides administered intravenously are usually low in the infected lung parenchyma. Nebulization represents an alternative to increase pulmonary concentrations, although the obstruction of bronchioles by purulent plugs may impair lung deposition by decreasing lung aeration. METHODS: An experimental bronchopneumonia was induced in anesthetized piglets by inoculating lower lobes with a suspension of 10(6) cfu/ml Escherichia coli. After 24 h of mechanical ventilation, 7 animals received two intravenous injections of 15 mg/kg amikacin, and 11 animals received two nebulizations of 40 mg/kg amikacin at 24-h intervals. One hour following the second administration, animals were killed, and multiple lung specimens were sampled for assessing amikacin pulmonary concentrations and quantifying lung aeration on histologic sections. RESULTS: Thirty-eight percent of the nebulized amikacin (15 mg/kg) reached the tracheobronchial tree. Amikacin pulmonary concentrations were always higher after nebulization than after intravenous administration, decreased with the extension of parenchymal infection, and were significantly influenced by lung aeration: 197 +/- 165 versus 6 +/- 5 microg/g in lung segments with focal bronchopneumonia (P = 0.03), 40 +/- 62 versus 5 +/- 3 microg/g in lung segments with confluent bronchopneumonia (P = 0.001), 18 +/- 7 versus 7 +/- 4 microg/g in lung segments with lung aeration of 30% or less, and 65 +/- 9 versus 2 +/- 3 microg/g in lung segments with lung aeration of 50% or more. CONCLUSIONS: In a porcine model of severe bronchopneumonia, the nebulization of amikacin provided 3-30 times higher pulmonary concentrations than the intravenous administration of an equivalent dose. The greater the lung aeration, the higher were the amikacin pulmonary concentrations found in the infected lung segments.
Nosocomial bronchopneumonia is a frequent complication in patients with chronic intratracheal intubation. Despite targeted antibiotic treatment, production of abundant bronchial secretion containing pathogen bacteria often tends to be chronic, and so mortality drastically increases. This problem led to an investigation of the penetration of five cephalosporin antibiotics into the sputum. Serum and sputum were collected from 24 chronically intubated patients having purulent nosocomial bronchopneumonia treated in an intensive care unit (ICU). Patients received the following doses intravenously every 24 h: five received 70 mg/kg of body weight cefuroxime, four received 110 mg/kg cefamandole, six received 80 mg/kg ceftriaxone, four received 80 mg/kg ceftazidime, and five received 80 mg/kg cefepime. Antibiotic concentrations in the serum and sputum were evaluated by capillary electrophoresis. MICs were determined for bacteria isolated from the purulent bronchial secretions. The mean levels of the cephalosporins in the sputum did not reach the MICs for the bacteria isolated from the same samples. Ceftriaxone was the only one of the investigated five cephalosporins that had a measurable concentration in the sputum (1.4 +/- 1.2 mg/liter). The low concentration of antibiotics in the purulent tracheobronchial secretion can be one of the many reasons for ineffective therapy of nosocomial bronchopneumonia in intubated patients in the ICUs. In the case of intubated or mechanically ventilated patients having chronic bronchopneumonia, determination of drug concentration in the bronchial secretion might be considered when selecting an antibiotic for treatment.
BACKGROUND: Community-acquired bronchopneumonia in children is frequently accompanied by extreme leukocytosis, whereas in adults with the same diagnosis a high leukocyte count is uncommon. Data regarding differences in the serum levels of inflammatory cytokines between children and adults are limited. OBJECTIVES: To compare leukocyte counts and blood levels of various inflammatory cytokines in children and adults diagnosed with community-acquired bronchopneumonia. METHODS: We prospectively evaluated all pediatric and adult patients admitted for bronchopneumonia based on clinical and chest X-ray findings. Blood was drawn for complete blood count and serum concentration of the following cytokines: granulocyte colony-stimulating factor, interleukins-6, 8 and 10, interferon-gamma, tumor necrosis factor, as well as matrix metalloproteinase-9 and intercellular adhesion molecule-1. RESULTS: There were 31 children and 32 adults. The patients in both groups had similar parameters of infection severity. None of them required admission to the Intensive Care Unit. Mean (+/- SD) leukocyte counts in the pediatric and adult groups were 21,018/mm3 (+/- 10,420) and 12,628/mm3 (+/- 6735) respectively (P = 0.02). Age was inversely correlated with leukocytes in the pediatric group (P = 0.0001). A significant inverse correlation was also found between age and platelet counts. Although cytokine levels in both groups were not significantly different, age was directly correlated with MMP-9 (P= 0.03), IL-8 (P= 0.03) and G-CSF (P= 0.014). CONCLUSIONS: The immune response in community-acquired bronchopneumonia is, at least partly, age-dependent.
The level of ascorbic acid in the blood plasma of 59 calves was determined. The age of the calves ranged between two and three months and the samples of blood were collected in January. The first group of calves included 30 animals displaying no clinical symptoms of disease: the average ascorbic acid level was 0.50 +/- 0.18 mg per 100 ml. In the second group, consisting of 19 calves, the blood of the animals was collected three weeks after the termination of the acute stage of bronchopneumonia; the average value of ascorbic acid was 0.30 +/- 0.14 mg per 100 ml. The lowest average value of ascorbic acid was obtained in the calves at an acute stage of bronchopneumonia, reaching 0.18 +/- 0.11 mg per 100 ml. The differences of results between groups I and II and between groups I and III were found to be statistically significant. A conspicuous drop of ascorbic acid level was ascertained in calves suffering from bronchopneumonia-this problem needs deeper scrutiny, owing to the fact that bronchopneumonia is responsible for considerable economic losses in large-capacity calf houses.
103 infants with acute obstructive bronchitis and/or bronchopneumonia were studied. IgM and alpha-1-antitrypsin values were determined by single radial immunodiffusion. In each infant the values were studies in eight serum samples. Comparison of the time of clinical recovery and x-ray clearing of the lung and the time of normalization of IgM and alpha-1-antitrypsin was also done. In infants with acute obstructive bronchitis the clinical recovery and X-ray clearing occurred on about the 13th day from the beginning of investigation. However, the normalization of IgM and alpha-1-antitrypsin values, which were significantly increased in all investigated serum samples, did not occur even on the 44th day of investigation. In infants with acute obstructive bronchitis associated with bronchopneumonia the clinical recovery occurred on the 10th day of investigation and X-ray clearing on the 14th day. IgM and alpha-1-antitrypsin values, which were also significantly increased in all investigated serum samples, were normalized on the 44th day of investigation. In group of infants with bronchopneumonia the clinical recovery occurred, approximatively, on the 12th day, whole the x-ray clearing occurred on the 17th day of investigation. IgM and alpha-1-antitrypsin values were normalized on the 18th day of investigation. In infants with acute obstructive bronchitis and/or bronchopneumonia there is significant correlation between IgM and alpha-1-antitrypsin values. This finding could be used to evaluate which of these two disease is dominant if they occur at the same time in infant.
Twelve calves from over veal calf farm were divided into two groups: group I-6 calves which developed typical signs of enzootic bronchopneumonia and group II-6 calves with no symptoms of the disease. Both groups of calves were compared with respect to changes in several hematological parameters. Some functions of peripheral blood leukocytes as random migration, phagocytic index, percent of phagocytic cells and percent of NBT positive cells were also scored. In addition, changes in serum levels of interferon (IFN) and tumor necrosis factor (TNF) and the ability of peripheral blood leukocytes (PBL) to produce IFN and TNF were quantitated by biological methods. On the day of diagnosis, in group I of calves a significant increase in the total serum protein concentration, hemoglobin content, red and white blood cells counts in comparison to control calves (group II) was observed. The increased number of NBT positive neutrophils and moderate levels of serum IFN and TNF correlated with elevated body temperature, breathing and heart rates. Calves with bronchopneumonia (group I) after diagnosis of the disease were treated with Tylbian (tylosine derivative), Flumetazon (glucocorticoid), Emulselvet (immunomodulator), bromhexinum and sulphonamides. Seven days after the beginning of treatment with medicaments a significant improvement in clinical symptoms was observed, however, the ability of PBL to cytokine production increased significantly 2 weeks after beginning of treatment and correlated with significant increase in random migration of neutrophils and their phagocytic activity, measured by the percent of phagocytic cells. Unexpectedly, in control calves (group II), not exhibiting any symptoms of bronchopneumonia at the beginning of experiment, high serum IFN titers were detected which decreased significantly during the first week of observation. In contrast to that the ability of PBL of control calves to produce IFN increased significantly within 3 weeks of observation. The correlations between the ability of PBL to produce cytokine and the development of clinical symptoms of bronchopneumonia are discussed.
The effects of monoclonal antibody (MAb) C179 recognizing a conformational epitope in the middle of the hemagglutinine (HA) stem region were examined in a mouse model in the experiments of prevention and treatment of lethal bronchopneumonia caused by influenza A virus of H5 subtype. To model the lethal infection, avian nonpathogenic strain A/mallard duck/Pennsylvania/10218/84 (H5N2) was adapted to mice. This resulted in highly pathogenic pneumovirulent mouse-adapted (MA) variant, which was characterized. Three amino acid changes were found in the HA1 subunit of HA of MA virus. One of these was located inside the region of the conformational epitope recognized by MAb C179. However, this substitution was not significant for the recognition of HA and virus neutralization by MAb C179 in vitro and in vivo. Intraperitoneal administration of two different concentrations of MAb C179 one day before or two days after the virus challenge significantly decreased mortality rate. These results suggest that MAb C179 is efficient not only in the prevention and treatment of H1 and H2 influenza virus bronchopneumonia, as was reported previously, but also of H5-induced bronchopneumonia as well, and demonstrate in vivo the existence of a common neutralizing epitope in the HAs of these three subtypes.
The incidence of postoperative bronchopneumonia in 70 patients undergoing upper abdominal surgery who received intramuscular and oral bromhexine after operation for 5 days was 25% (8 of 32), compared with 34% (13 of 38) in a control group, but this difference in favour of bromhexine does not reach statistical significance. All patients had postoperative physiotherapy. However, in a high-risk group (patients who smoked more than 10 cigarettes a day, who admitted to a productive cough before the operation and in whom the forced expiratory volume as a percentage of the forced vital capacity was less than 70) the incidence of postoperative bronchopneumonia in those who had bromhexine was 6 of 17 compared with 9 of 15 in the controls. Thus bromhexine for the prevention and treatment of postoperative bronchopneumonia in high-risk patients after upper abdominal surgery deserves further study.
This study aimed to investigate whether Escherichia coli endotoxin (LPS) may predispose the lung to an infection with Pasteurella multocida type A (Pma) and to determine the LPS concentration needed to reproduce clinical signs of bronchopneumonia. Twenty-four hours before inoculating Pma or sterile growth medium, piglets were tracheally instilled with 10, 100 or 400 microg/kg LPS. Cough, body temperature, daily weight gain (DWG) bronchoalveolar lavage fluid (BALF) cells and volume of pneumonic lung were measured. Changes in breathing pattern (Penh) were assessed by whole body barometric plethysmography. No significant changes were observed in Pma-treated or in control animals. Each LPS doses induced DWG reduction while the higher generated a severe subacute interstitial pneumonia causing hyperthermia and an increase in Penh. The combination of the lower LPS doses with Pma produced an asymptomatic bronchopneumonia leading to DWG reduction, rise in Penh and an increase in BALF macrophages and neutrophils. With 400 microg/kg LPS, Pma worsened the inflammatory process as illustrated by cough, hyperthermia, major DWG reduction and by a greater Penh response. Lung lesions consisted of severe exudative bronchopneumonia. We concluded that LPS may negatively influence growth, predispose to persisting lung inflammatory process and promote Pma infection depending on the dose previously administered.
An epidemic of bronchopneumonia in infants and young children, with adenovirus type 21 infection, was observed in Auckland, New Zealand, in 1977. Eighteen children, four to 44 months of age, with clinical and radiologic evidence of bronchopneumonia are described. Several of the children were seriously ill but there were no deaths. When reviewed six to 12 months after diagnosis, six children had clinical signs and 13 had radiologic signs of residual pulmonary disease. There were no detectable pulmonary sequelae in two children. Three children were lost to follow-up and could not be evaluated. Adenovirus type 21 bronchopneumonia is a serious illness and an important cause of chronic bronchopneumopathy in infants and young children.